Dossa Nissou Ines, Zunzunegui Maria Victoria, Hatem Marie, Fraser William
Département de médecine sociale et préventive, École de Santé Publique de l'Université de Montréal, Montreal, QC, Canada.
Birth. 2014 Mar;41(1):5-13. doi: 10.1111/birt.12085.
Sexual violence (SV) is being used widely as a weapon of war. However, few studies have investigated its health effects. The objective of the present study is to investigate the relationship between sexual violence and several serious reproductive health conditions including fistula.
We conducted a cross-sectional study among 320 women living in Goma, the Democratic Republic of Congo. We assessed the association of four outcomes: fistula, chronic pelvic pain, desire for sex, and desire for children, with SV in two contexts: conflict-related and nonconflict-related. Two groups of women: those who experienced conflict-related sexual violence (CRSV) and those who experienced nonconflict-related sexual violence (NCRSV), were compared with women who had not experienced SV. Data were collected by trained interviewers using a standard questionnaire.
Compared with women who did not experience SV, after adjustment for potential confounders, women who experienced CRSV were significantly more likely to have fistula (OR = 11.1, 95% CI [3.1-39.3]), chronic pelvic pain (OR = 5.1, 95% CI [2.4-10.9]), and absence of desire for sex (OR = 3.5, 95% CI [1.7-6.9]) and children (OR = 3.5, 95% CI [1.6-7.8]). Women who experienced NCRSV were more likely to report absence of desire for children (OR = 2.7, 95% CI [1.1-6.5]), and seemed more likely to report chronic pelvic pain (OR = 2.3, 95% CI [0.95-5.8]), although the difference was not statistically significant. Women who experienced NCRSV did not have higher odds for fistula and absence of sexual desire.
Conflict-related sexual violence can contribute to women's adverse reproductive health outcomes. Its impact is more devastating than that of NCRSV.
性暴力正被广泛用作战争武器。然而，很少有研究调查其对健康的影响。本研究的目的是调查性暴力与包括瘘管病在内的几种严重生殖健康状况之间的关系。
我们在刚果民主共和国戈马的320名女性中进行了一项横断面研究。我们评估了在冲突相关和非冲突相关两种情况下，瘘管病、慢性盆腔疼痛、性欲以及生育意愿这四种结果与性暴力之间的关联。将两组女性进行比较：经历过冲突相关性暴力（CRSV）的女性和经历过非冲突相关性暴力（NCRSV）的女性，与未经历过性暴力的女性进行比较。数据由经过培训的访谈员使用标准问卷收集。
与未经历过性暴力的女性相比，在对潜在混杂因素进行调整后，经历过CRSV的女性患瘘管病（比值比[OR]=11.1，95%置信区间[CI][3.1 - 39.3]）、慢性盆腔疼痛（OR = 5.1，95% CI [2.4 - 10.9]）、缺乏性欲（OR = 3.5，95% CI [1.7 - 6.9]）和生育意愿（OR = 3.5，95% CI [1.6 - 7.8]）的可能性显著更高。经历过NCRSV的女性更有可能报告缺乏生育意愿（OR = 2.7，95% CI [1.1 - 6.5]），并且似乎更有可能报告慢性盆腔疼痛（OR = 2.3，95% CI [0.95 - 5.8]），尽管差异无统计学意义。经历过NCRSV的女性患瘘管病和缺乏性欲的几率没有更高。
冲突相关性暴力会导致女性出现不良生殖健康后果。其影响比非冲突相关性暴力更具破坏性。
